The Trump administration is recommending that doctors prescribe the opioid-overdose reversal drug naloxone when they give opioid painkillers to certain patients, a move aimed at reversing the scourge of overdoses across the country.
In guidance released Wednesday, health officials recommended that prescriptions such as Percocet, Vicodin, OxyContin, and Tramadol be accompanied with naloxone under certain conditions, such as when patients receive high doses of opioids, of about 10 pills of Vicodin, or when they take other medications, such as Valium.
Officials also recommended co-prescribing for patients with addictions to alcohol, cocaine, or methamphetamine, or who have a mental health disorder.
“This is not a mandate or anything of the sort,” Dr. Brett Giroir, the Department of Health and Human Services assistant secretary for health and senior adviser for opioid policy, said in a phone call with reporters. “It’s still in the scope of guidelines and strong recommendations. This is voluntary among prescribers. But we do believe the rates we are seeing of co-prescribing are exceedingly low.”
Naloxone for people to use at home can come in the form of a nasal spray, known as Narcan, or an auto-injector known as Evzio. It awakens people who have passed out and stopped breathing, and if given quickly, can save their lives. Naloxone is not a treatment for addiction, and people with a dependency on opioids may overdose and be reawakened by the drug several times over the course of their lives. Advocates have pointed to a need to not only to expand access to naloxone, but also to medications that help to treat addiction, such as buprenorphine.
The Trump administration is responding to federal data showing that 11.1 million people have misused prescription painkillers and that opioids from painkillers to illicit heroin and fentanyl claimed the lives of 47,000 people in 2017.
The Centers for Disease Control and Prevention had already issued similar recommendations, but HHS officials say that in looking at monthly data they believe co-prescribing is far too low.
Certain states have already passed laws requiring co-prescribing, and companies that manufacture naloxone have been encouraging the administration to institute a national policy. Some critics worry that co-prescribing will lead to shortages and price hikes.
Giroir said he was aware of such concerns and that the administration would be watching the trends carefully, as well as working with manufacturers. Most health insurance plans, including Medicare and Medicaid, cover the drugs.
Part of the aim in co-prescribing, Giroir said, was to “force the conversation” between doctors and patients so that they could be better informed about the risks of taking opioids. He noted that some patients may, upon finding out a painkillers’ potential for addiction and death, tell doctors that they prefer to try something else to manage their pain.
“This is not the 1920s,” he said. “It’s not ‘go to the doctor, get a prescription, and don’t ask questions.’ Every area of healthcare should be a shared decision … where the patient takes an active role in their healthcare.”
